Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication

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2011
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Wegwarth, Odette
Gigerenzer, Gerd
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Medical Decision Making. 2011, 31(3), pp. 386-394. ISSN 0272-989X. eISSN 1552-681X. Available under: doi: 10.1177/0272989X10391469
Zusammenfassung

Background

Increased 5-y survival for screened patients is often inferred to mean that fewer patients die of cancer. However, due to several biases, the 5-y survival rate is a misleading metric for evaluating a screening’s effectiveness. If physicians are not aware of these issues, informed screening counseling cannot take place.

Methods
Two questionnaire versions ("Group" and "time") presented 4 conditions: 5-y survival (5Y), 5-y survival and annual disease-specific mortality (5YM), annual disease-specific mortality (M), and 5-y survival, annual disease-specific mortality, and incidence (5YMI). Questionnaire version "time" presented data as a comparison between 2 time points and version "group" as a comparison between a screened and an unscreened group. All data were based on statistics for the same cancer site (prostate). Outcome variables were the recommendation of screening, reason- ing behind recommendation, judgment of the screening's effectiveness, and, if judged effective, a numerical esti- mate of how many fewer people out of 1000 would die if screened regularly. After randomized allocation, 65 Ger- man physicians in internal medicine and its subspecial- ities completed either of the 2 questionnaire versions.

Results
Across both versions, 66% of the physicians recommended screening when presented with 5Y, but only 8% of the same physicians made the recommenda- tion when presented with M (5YM: 31%; 5YMI: 55%). Also, 5Y made considerably more physicians (78%) judge the screening to be effective than any other condition (5YM: 31%; M: 5%; 5YMI: 49%) and led to the highest overestimations of benefit. Conclusion. A large number of physicians erroneously based their screening recommendation and judgment of screening's effectiveness on the 5-y survival rate. Results show that reporting disease-specific mortality rates can offer a simple solution to phy- sicians' confusion about the real effect of screening.

Zusammenfassung in einer weiteren Sprache
Fachgebiet (DDC)
150 Psychologie
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decision rules, risk communication or risk perception, shared decision making, health literacy, numeracy
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undefined / . - undefined, undefined
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ISO 690WEGWARTH, Odette, Wolfgang GAISSMAIER, Gerd GIGERENZER, 2011. Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication. In: Medical Decision Making. 2011, 31(3), pp. 386-394. ISSN 0272-989X. eISSN 1552-681X. Available under: doi: 10.1177/0272989X10391469
BibTex
@article{Wegwarth2011-05Decei-28050,
  year={2011},
  doi={10.1177/0272989X10391469},
  title={Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication},
  number={3},
  volume={31},
  issn={0272-989X},
  journal={Medical Decision Making},
  pages={386--394},
  author={Wegwarth, Odette and Gaissmaier, Wolfgang and Gigerenzer, Gerd}
}
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    <dcterms:abstract xml:lang="eng">Background&lt;br /&gt;&lt;br /&gt;Increased 5-y survival for screened patients is often inferred to mean that fewer patients die of cancer. However, due to several biases, the 5-y survival rate is a misleading metric for evaluating a screening’s effectiveness. If physicians are not aware of these issues, informed screening counseling cannot take place.&lt;br /&gt;&lt;br /&gt;Methods&lt;br /&gt;Two questionnaire versions ("Group" and "time") presented 4 conditions: 5-y survival (5Y), 5-y survival and annual disease-specific mortality (5YM), annual disease-specific mortality (M), and 5-y survival, annual disease-specific mortality, and incidence (5YMI). Questionnaire version "time" presented data as a comparison between 2 time points and version "group" as a comparison between a screened and an unscreened group. All data were based on statistics for the same cancer site (prostate). Outcome variables were the recommendation of screening, reason- ing behind recommendation, judgment of the screening's effectiveness, and, if judged effective, a numerical esti- mate of how many fewer people out of 1000 would die if screened regularly. After randomized allocation, 65 Ger- man physicians in internal medicine and its subspecial- ities completed either of the 2 questionnaire versions.&lt;br /&gt;&lt;br /&gt;Results&lt;br /&gt;Across both versions, 66% of the physicians recommended screening when presented with 5Y, but only 8% of the same physicians made the recommenda- tion when presented with M (5YM: 31%; 5YMI: 55%). Also, 5Y made considerably more physicians (78%) judge the screening to be effective than any other condition (5YM: 31%; M: 5%; 5YMI: 49%) and led to the highest overestimations of benefit. Conclusion. A large number of physicians erroneously based their screening recommendation and judgment of screening's effectiveness on the 5-y survival rate. Results show that reporting disease-specific mortality rates can offer a simple solution to phy- sicians' confusion about the real effect of screening.</dcterms:abstract>
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